Nasal Fracture In Children

WHAT YOU SHOULD KNOW:

A nasal fracture (FRAK-chur) is also called a broken nose. This occurs when any of your child's bones in the nose are broken. Nasal fractures are the most common facial fractures since the nose is a prominent part of the face. The nose is the main gate to the respiratory (breathing) system. Nasal fractures may be caused by an injury or trauma to the face. A fall from a height, direct blow during a fight, physical abuse, or a car accident may cause nasal fractures.

Common signs and symptoms may include a bump, cut, bruise, swelling, or deformity on his nose. He may also have trouble breathing, smelling, or talking. Nasal endoscopy or nasal speculum exam may be used for diagnosis. Other tests, such as x-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scan may also be done.

Treatment may include medicines for the relief of symptoms, or surgery if the fracture is bad. Most nasal fractures heal faster in children than in adults. The younger your child is, the faster the fracture will heal without further problems. With proper treatment, care and follow-up, your child has a greater chance of having a full recovery. Ask your caregiver for information about these tests and treatments.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

Treatment for a nasal fracture may cause unwanted side effects. Medicines may cause your child to have nausea (upset stomach), vomiting (throwing up), or stomach ulcers (sores). He may bleed or get an infection if he has surgery. If left untreated, the fractured bones may not heal the right way and get worse. A nasal injury may also cause bleeding, hematoma (blood clots), deformity, or infection.

If not treated early, there may become permanent injury, like nerve damage or trouble breathing. Diagnosis and treatment of your child's nasal fracture as soon as possible is very important. Call your child's caregiver if you have concerns about his fracture, medicines, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

Activity:

At first your child may need to rest in bed. He may need to breathe through his mouth or lean forward especially when sitting. He may use 2 to 3 pillows when he lies down. This will help your child breathe easier. His caregiver will tell you when it is OK to get him out of bed. Call your child's caregiver before getting him up for the first time. If he ever feels weak or dizzy, have him sit or lie down right away.

Emotional support:

You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask caregivers if another family member can stay with your child when you cannot be there. Bring in something from home that your child likes. Your child may like to have his favorite blanket, toy, or clothing with him.

Ice:

An ice pack may be applied to your child's skin on top of the swollen part of the nose to decrease swelling. An ice pack is made of crushed or cubed ice in a plastic bag or an ice pack. Some water is mixed in a bag with the ice to more evenly distribute the cold. Wrap the ice bag in a towel. Do not place the ice bag directly on the skin. Do not leave the ice pack on the skin for a long time to avoid skin damage.

IV:

An IV is a tiny tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Medicines:

Your child may need one or more of the following:

Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.

Tetanus shot: This medicine keeps your child from getting tetanus. It is given as a shot. Your child should have a tetanus shot if he has not had one in the past 5 to 10 years. Your child's arm can get red, swollen, and sore after getting this shot.

Nasal decongestants: This medicine decreases the swelling in the nose to make breathing easier. Decongestants can be taken orally or by nasal drops or spray.

Pain medicine: Caregivers may give medicine to decrease your child's pain. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.

Mouth care:

You may need to help clean your child's mouth everyday. Cleaning your child's mouth will remove pieces of food and clean his teeth. A water pik or a small soft toothbrush will work well to clean your child's mouth. Ask your child's caregivers for more information about proper mouth care.

Oxygen:

Your child may need oxygen to help him breathe easier. Your child may need a nasal cannula (small tubes placed in the nose) or mask. Many children do not like having these on their face, so caregivers may place the mask next to your child's face. Some children are placed in an oxygen tent or plastic hood. Do not take off your child's oxygen without asking your child's caregiver first.

Neurologic signs:

These are also called neuro signs, neuro checks, or neuro status. A caregiver may check your child's eyes, memory, and how easily your child wakes up. The strength of your child's arms, hands, legs, and feet may also be checked. These signs may tell caregivers how your child's brain is working.

Tests:

Blood tests:

Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.

Your child may need one or more of the following:

Nasal endoscopy: This test, also known as anterior rhinoscopy, uses a scope to see the inside of your child's nose. A scope is usually made of a long, bendable tube with a light on the end of it. During a nasal endoscopy, pictures are taken by a small camera attached to the scope.

Nasal speculum exam: Caregivers will use bright light and an instrument called speculum to check the inside of your child's nose. This gently spreads open his nostrils to look for any blood clots or swelling.

Other tests:

X-rays: Your child may need to have x-rays of his nose, face, and head taken to check for broken bones or other problems.

Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your child's nose, face, and head. Your child may be given a dye before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if he is allergic to shellfish, or has other allergies or medical conditions.

Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your child's nose, face, and head. During an MRI, pictures are taken of his bones, brain, or blood vessels. He will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.

Treatment options:

Your child may need one or more of the following:

Closed reduction: Caregivers may realign the broken bones or bring the nose back to its original position. This is done by moving the nasal bones and septum without opening the skin.

Device: Your child's nose may need to be fixed or supported with splints. A splint may be placed inside or over the top of his nose.

Irrigation and debridement: This is done to clean and remove objects, dirt, or dead tissues from the fractured area.

Nasal packing: Caregivers may pack your child's nose with gauze (bandage) strips to control bleeding and prevent infection. These strips are moistened (wet) with salt solution or antibiotic ointment.

Surgery: Your child may need surgery to return the bones to their normal position if the fracture is bad. Surgery may also be needed to correct a deformity or fix damaged tissues on the nose. Blood clots in the nose may be removed by making a small incision (cut) in your child's nose. Injury to the other parts of the nose, nerves, or blood vessels may also be treated with surgery.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.